Children with a history of frequent emergency department (ED) care and hospitalizations are at the greatest risk for increased asthma morbidity including decreased quality of life, increased school absences and life threatening asthma. Cost of care in treating pediatric asthma is high. Parental and child ability to accurately communicate symptoms to the physician is critical for optimal asthma diagnosis and treatment. When linked to timely and appropriate asthma medication use, accurate physician-parent-child communication may result in decreased asthma morbidity. Early self-administration of inhaled asthma medications was reported at a mean age of 8 years for inner-city children. Despite this early age of asthma self-management, little research focuses on the child's contribution to the medical encounter. This study is designed to determine if a parent and child asthma communication intervention (ACI) will be associated with AIM 1:enhanced communication skills of the parent and child, AIM 2:reduced asthma morbidity, AIM 3: enhanced appropriate adherence to asthma medication based on pharmacy refill rates and AIM 4: demonstrate cost effectiveness as compared to children enrolled in a standard asthma education intervention (SAE). Differences in ED visits for asthma, hospital days, number of urgent and primary care visits, school absences, restricted activity, number of symptom days and nights, functional status, quality of life over the 18 month follow-up will be compared between the two groups (ACI and SAE). The University of Maryland Hospital Pediatric ED, inpatient unit and Community pediatric clinics will serve as our recruitment sites. Families of children with mild-severe persistent asthma ages 6-12 years (N=220) will be enrolled. Data analysis will include chi-square, t-tests, ANOVA and multivariate linear regression models. The Generalized Estimating Equation (GEE) will be used to address the correlation of repeated measures. Cost-effectiveness and cost benefit ratios will be generated to examine for differences in cost of care between groups. Study outcomes will provide important data on the effects of an asthma communication intervention for children with mild to severe persistent asthma, the relative cost of the intervention; and the major components required to meet the needs of children with mild to severe asthma. Study findings will improve clinical care to this vulnerable population of children as well as children with other chronic illness and will be of significant use to health care providers, researchers, insurers and policy makers and will have significant public health applicability.